SAEM Clinical Image Series: Rash After a Sore Throat and Ibuprofen Use

By |Categories: Dermatology, SAEM Clinical Images, Tox & Medications|

[Click for larger view] Chief complaint: Rash History of Present Illness: The patient is an 18 year-old male who presents with a rash that appeared 7 days ago. The rash is located on his torso, back, and lower lip. It is pruritic. Three days prior to the appearance of the rash, he had a sore throat and intermittently took ibuprofen over the ensuing 3 days. He stopped taking ibuprofen 4 days after his sore throat abated. He denies any fever, nausea, vomiting, shortness of breath, chest pain, abdominal pain, diarrhea, extended travel in the [...]

New free P3 app: PECARN Publication Prospectus

By |Categories: Pediatrics|

One of the gold standard for building and sustaining collaborative, multi-institutional research networks in medicine is the Pediatric Emergency Care Applied Research Network (PECARN) organization. Their efforts on studying pediatric emergency care has resulted some of our specialty’s landmark papers in Lancet, New England Journal of Medicine, JAMA Pediatrics, and Annals of Emergency Medicine. Although we are not officially affiliated with them, we fully support their efforts and wanted to help disseminate their evidence-based findings with an educations. Thus was born the PECARN Publication Prospectus (P3) app project [download free P3 app]. […]

SAEM Clinical Image Series: Another Heart Attack?

By |Categories: Cardiovascular, ECG, SAEM Clinical Images, Ultrasound|

[Figure 1: Click for larger view] Chief Complaint: Chest pain History of Present Illness: An 89-year-old female with a past medical history of coronary artery disease and with recent admission for myocardial infarction that was medically managed, presented with chest pain and shortness of breath. She reports worsening midsternal chest pain that occasionally radiates to her back and right arm since discharge. […]

SAEM Clinical Image Series: Flu-like symptoms, oral ulcers, and rash

By |Categories: Allergy-Immunology, Dermatology, Genitourinary, SAEM Clinical Images|

[Click for larger view] Chief Complaint: Flu-like symptoms, lip pain/swelling, mouth pain, eye redness, and rash History of Present Illness: Patient is a 35-year-old transgender male with a history of bipolar disorder (taking seroquel/lamotrigine) who presents with 2 days of: Flu-like symptoms Progressive lip pain/swelling Mouth pain Oral ulcers Eye redness New erythematous rash involving the palms/soles and lower extremities The patient initially noted myalgias, fever, and malaise 2 days ago. Yesterday, the patient woke up with bilateral eye redness and itching, and he developed lip swelling/discoloration and mouth pain throughout the day. He presented [...]

  • constipation

Trick of Trade: Topical lidocaine jelly to make constipation relief less painful

By |Categories: Gastrointestinal, Tricks of the Trade|

Severe constipation, requiring fecal disimpaction and rectal enemas, can be excruciatingly painful for patients. Administering sedatives and opioids to help alleviate this pain poses a challenge, because many of the patients are elderly and tend to be more sensitive to these medications. Furthermore, there may be increased vagal tone when straining, leading to hypotension and bradycardia and which can result in defecation-related syncope. 1 Also, opioids can exacerbate constipation. Herein we present 2 cases and tricks on achieving better pain control. […]

  • strep pharyngitis

Strep Pharyngitis in Children: Review of the 2012 IDSA Guidelines

By |Categories: ENT, Guideline Review, Infectious Disease, Pediatrics|

Sore throat accounts for a whopping 7.3 million outpatient pediatric visits. Group A Streptococcus (GAS) accounts for 20-30% of pharyngitis cases with the rest being primarily viral in etiology. However, clinically differentiating viral versus bacterial causes of pharyngitis is difficult and we, as providers, often don’t get it right. In addition, antimicrobial resistance is increasing.. So who do we test and when do we treat for strep throat? The 2012 Infectious Diseases Society of America (IDSA) guideline on GAS pharyngitis helps answer these questions. […]

SplintER Series: Ankle Dislocation | Leg Day #4

By |Categories: Expert Peer Reviewed (Clinical), Orthopedic, SplintER|

Welcome to Leg Day #4 of the SplintER Series! Ankle dislocations are an emergent condition in the Emergency Department (ED) that requires expert-level examination and management. We review the pertinent and subtle sports medicine examination and management techniques that will help you feel in control from time of presentation to disposition.  […]

SAEM Clinical Image Series: Fishing in Papua New Guinea

By |Categories: SAEM Clinical Images, Trauma|

[Click for larger view] Chief Complaint: Right lower extremity injury while spear fishing History of Present Illness: A 33-year-old male went river fishing with a homemade spear and diving mask in Papua New Guinea. He felt sudden pain and tugging to the right lower extremity. He was near shore and grabbed a tree root. He held on for dear life as he was being pulled back into the water. It felt as if his foot had been torn off. He did not let go of the tree root and eventually the pulling force ceased. He [...]

  • lunate dislocation xray

SplintER Series: A Case of Traumatic Wrist Pain After Fall on Outstretched Hand

By |Categories: Expert Peer Reviewed (Clinical), Orthopedic, SplintER|

A 46 year-old male presents with wrist pain after sustaining a mechanical fall and catching himself on his outstretched hand. An anteroposterior (left) and lateral (right) plain films of the wrist are obtained (photo credit). What is the diagnosis (hint – there are 2 findings), injury classification system, associated findings, and the recommended management plan? […]

SAEM Clinical Image Series: Distended Bowels

By |Categories: Gastrointestinal, SAEM Clinical Images|

[Click for larger view] Chief Complaint: Abdominal distention History of Present Illness: A 36-year-old male with a history of cerebral palsy, gastrointestinal dysmotility, epilepsy, hypertension, gastroesophageal reflux disease, and insomnia presents to the ED after referral by his family physician for a 3-day history of abdominal distention. Due to the patient’s neurological disorder, he is unable to communicate but is accompanied by his mother who provides his medical history. The patient’s mother states that he had a loose bowel movement this morning, which is normal for him. He has had a history of bowel problems [...]